Can a Virtual Clinic Review Replace a Surgical Clinic Visit after Discharge? A Randomized Controlled Trial

Abstract

DRG) coding. Net margins were calculated as the difference between hospital costs and reimbursements. RESULTS: A total of 167 patients were reviewed. Mean age was 41.2 years, with 53% male. Mean length of stay was 3.7 days (range 1e17 days). The 30-day and 90-day readmission rates were 4.8% and 6.0%, respectively. Average hospital costs were substantially higher for procedures with complicated principal diagnosis (MS-DRG 338e340, $8,521) compared to those with uncomplicated principal diagnosis (MS-DRG 341e343, $5,708), highlighting the variability in clinical presentation. The average cost among all patients was $7,885 (range $3,335e$25,541), resulting in a net margin (loss) of À$206 per patient, with 40% of patients contributing to an overall negative margin. Ninety-day readmissions increased the average cost per patient to $8283. Under a bundled payment model using the average reimbursement ($7,679) for the index admission, the net margin per patient would be (loss) À$604, with 42% of patients contributing to a net negative margin. CONCLUSIONS: Longer hospital stays and higher complication rates significantly increase the overall cost of appendectomy. Due to the heterogeneous nature of patients requiring appendectomy, current reimbursement systems may undercompensate hospitals delivering care to these patients, and future bundled payment models should reflect the true cost of care.

Efficacy of physician associate delivered virtual outpatient clinic

“…The use of so-called virtual clinics, delivered by different grades of staff, are described in several specialties including orthopaedics, general surgery, respiratory and urology (Gupta et al, 2018;Healy et al, 2017;Miah et al, 2018;Goncalves et al, 2016;Jayaram et al, 2014). There are many benefits reported in having this service readily available.…”